Orbital cyst due to Histoplasma duboisii.
A cystic swelling in the orbit due to Histoplasma duboisii, clinically thought to be a dermoid cyst, is described.
Adult↗
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Histoplasma endocarditis on a stenosed aortic valve presenting as dysphagia and weight loss.
A 40-year-old man with aortic stenosis and disseminated histoplasmosis did not respond to treatment with itraconazole. Though there was no haemodynamic deterioration, valvar regurgitation, or embolic phenomena a presumptive diagnosis of infective endocarditis was made. This was confirmed at aortic valve replacement. Antifungal treatment was continued for 18 months after valve replacement and serological tests for Histoplasma became progressively more negative during a three year follow up.
Adult↗
A case of Histoplasma capsulatum causing granulomatous liver disease and Addisonian crisis.
A 56-year-old man with persistently elevated liver enzyme levels, fatigue, lethargy and a 9.0 kg weight loss over six months underwent a percutaneous liver biopsy that demonstrated multiple granulomas. Screening serologies were positive for histoplasmosis, and he was started on itraconazole treatment. He returned to hospital the same night with coffee-ground emesis and in Addisonian crisis requiring parenteral steroids and intensive care unit support. An abdominal computed tomography scan revealed bilaterally enlarged, nonenhancing adrenal glands suggestive of infarcts, presumed secondary to histoplasmosis. Treatment was initiated with amphotericin B, and Histoplasma capsulatum was cultured from his urine and cerebrospinal fluid. A serum immunodiffusion test was also positive for both H and M bands, indicating active infection with Histoplasmosis species. His serum and urine samples were also weakly positive for the antigen. Despite complications of renal failure, pneumonia and congestive heart failure, he recovered with medical therapy and was discharged home to complete a prolonged course of itraconazole therapy. While hepatic granulomas often reflect an occult disease process, the cause may remain undiscovered in 30% to 50% of patients despite exhaustive investigations. H capsulatum is an uncommon cause of granulomatous liver disease, and with its protean clinical presentation, a high index of suspicion is needed to make the diagnosis and avoid the potentially high fatality rate associated with disseminated infection.
Addison Disease↗
[Histoplasma capsulatum infection in a group of travelers to Guatemala].
OBJECTIVE: To analyze the epidemiological and clinical characteristics of Histoplasma capsulatum infection in a group of volunteers who had traveled to Guatemala. METHODS: A review was performed of the clinical records of nine patients who consulted at the Tropical Medicine Outpatient Unit of Hospital Clinic in Barcelona, Spain. RESULTS. All patients were attended for travelers' diarrhea. In addition, one student had also presented with respiratory symptoms and fever while in Guatemala and her chest X-ray showed interstitial infiltrates. The epidemiological history recognized risk factors for histoplasmosis in all patients (all of them had been working in the reconstruction of an old school building). The intradermal histoplasmin test was performed and was positive in all nine patients. None of the students required treatment. CONCLUSIONS: Histoplasmosis should be included in the differential diagnosis of returning travelers' fever. The diagnosis would have been missed in all of our patients if not for a directed clinical history taking. It is important to reinforce prevention measures, e.g. the use of face masks, when working in an environment with a risk for acquiring histoplasmosis.
Adult↗
Chronic Histoplasma capsulatum infection of the central nervous system successfully treated with fluconazole.
A 48-year-old man with a long-standing history of communicating hydrocephalus is reported. Ventriculoperitoneal shunting led to clinical improvement, but symptoms recurred despite surgical re-exploration switching the shunt to an atrial drainage. Ten months after the last surgical procedure, an acute myelopathy developed. Concomitant pharyngeal granuloma examination identified Histoplasma capsulatum (Hc) yeasts. Despite initial response to amphotericin B, Hc was isolated from cerebrospinal fluid (CSF), valve reservoir and distal catheter after two courses of therapy. Fluconazole successfully sterilized CSF, but transverse myelopathy persisted unchanged, and shunting was needed to control hydrocephalus.
Cerebrospinal Fluid Shunts↗
Diagnosis of histoplasmosis in patients with the acquired immunodeficiency syndrome by detection of Histoplasma capsulatum polysaccharide antigen in bronchoalveolar lavage fluid.
Diagnosis of histoplasmosis in patients with Acquired Immunodeficiency Syndrome (AIDS) may be established by detection of the organism in lung tissue or bronchoalveolar lavage fluid. In this report we have evaluated the utility of Histoplasma capsulatum polysaccharide antigen (HPA) detection in bronchoalveolar lavage fluid for diagnosis of histoplasmosis. HPA was detected in bronchoalveolar lavage fluid of 19 of 27 cases (70.3%). Of 122 controls with a variety of underlying diseases, HPA was detected in none. Eight of the negative specimens from patients with histoplasmosis were retested after fivefold concentration, and HPA was detected in five. Fivefold concentration of 10 control samples had no effect on HPA level. H. capsulatum was seen by methenamine silver or Giemsa stain in 19 of the 27 (70.3%) and isolated by culture in 24 of 27 (88.9%) cases. Twenty-four of 26 (92.3%) cases had positive cultures from extrapulmonary sites as well. HPA was detected in the urine of 25 (92.6%) and the serum of 23 (88.5%) of the 26 cases. We conclude that HPA detection offers a rapid method for identification of pulmonary histoplasmosis in patients with AIDS and could be a helpful addition to the battery of tests performed on bronchoalveolar lavage fluids in areas where histoplasmosis is endemic.
Acquired Immunodeficiency Syndrome↗
Filamentous Histoplasma capsulatum involving a ventriculoatrial shunt.
We describe the first case, to our knowledge, of filamentous Histoplasma capsulatum infection in a ventriculoatrial shunt. A review of the literature on the incidence, etiologies, and symptomatology of shunt-related infections is presented. The pathogenesis and treatment of the fungus-infected shunts are also discussed.
Cerebrospinal Fluid Shunts↗
Broncholithiasis due to Histoplasma capsulatum subsequently infected by actinomycetes.
A case of broncholithiasis in which both Histoplasma and actinomycotic organisms were demonstrated is presented. The etiology of broncholithiasis is discussed, with particular emphasis on the relationship between the organisms identified.
Actinomycosis↗
Atypical disseminated cutaneous histoplasmosis in an immunocompetent child, caused by an "aberrant" variant of histoplasma capsulatum var. capsulatum
A case of atypical disseminated cutaneous histoplasmosis in a five-year old, otherwise healthy child, native and resident in Sao Paulo metropolitan area is reported. Cutaneous lesions were clinically atypical. Histologic examination disclosed a granulomatous reaction but no fungal structures could be demonstrated by specific staining nor by immunohistochemical reaction. The fungus was isolated from biopsy material on two different occasions, confirming diagnosis of an unusual fungal infection. The fungus, originally thought to be a Sepedonium sp. due to the large sized, hyaline or brownish colored tuberculated macroconidia and to lack of dimorphism (yeast form at 37 degrees C) produce H and M antigens, visualized by the immunodiffusion with rabbit anti-Histoplasma capsulatum hyperimmune serum. Patient's serum sample was non reactive with H. capsulatum antigen by immunodiffusion, counterimmunoelectrophoresis and complement fixation tests, and immunoenzymatic assay failed to detect the specific circulating antigen. This serum was tested negative by double immunodiffusion when antigen obtained from one of the isolated samples was used. Both cultures were sent to Dr. Leo Kaufman, Ph.D. (Mycoses Immunodiagnostic Laboratory, CDC-Atlanta/USA), who identified them as H. capsulatum by the exoantigen and gen-probe tests. Both clinic and mycologic characteristics of the present case were atypical, suggesting the fungus isolated is an "aberrant variant" of H. capsulatum var. capsulatum, as described by SUTTON et al. in 1997. Treatment with itraconazole 100 mg/day led to cure within 90 days
Journal Article↗
Intramedullary spinal Histoplasma granuloma. Case report.
While there have been several cases of cerebral histoplasmoma published in the literature, the occurrence of such a lesion in an intramedullary spinal location has not previously been reported. The authors present a patient with a Brown-Séquard lesion secondary to an intramedullary Histoplasma granuloma in the cervical region. The case was successfully managed with surgical removal of the lesion.
Adult↗
V beta 6+ and V beta 4+ T cells exert cooperative activity in clearance of secondary infection with Histoplasma capsulatum.
We previously studied the lung Vbeta TCR repertoire of C57BL/6 mice during primary infection with the pathogen Histoplasma capsulatum. We observed a consistent oligoclonal expansion of Vbeta4(+) T cells during the peak of infection and early stages of resolution. The Vbeta4(+) family played a role in protective immunity against the fungus. Depletion of this subpopulation of T cells hindered optimal clearance of infection from tissues. In this report we analyze the flux of the Vbeta TCR repertoire in the lungs of C57BL/6 mice with reinfection histoplasmosis. We observed a significant increase in Vbeta6(+) T cells on days 7, 10, and 14, the peak and early resolution phases of infection. This skewing was preceded by an increased number of memory T cells within Vbeta6(+) cells. The VDJ sequences of Vbeta6 chains were oligoclonal during the early stages of the infection, suggesting that the expansion was driven by a small number of Ags. More than 96% of the expanded Vbeta6(+) cells were CD4(+). Depletion of Vbeta6(+) T cells but not Vbeta4(+) T cells induced a modest but significant delay in fungal clearance. Simultaneous depletion of Vbeta4(+) and Vbeta6(+) T cells induced a more pronounced impairment of host resistance. These studies illustrate the dynamic interactions between Vbeta families in the response to microbial challenge.
Amino Acid Sequence↗
Histoplasma meningitis: diagnostic value of cerebrospinal fluid serology.
Two patients with culture-negative chronic meningitis were diagnosed as having Histoplasma capsulatum meningitis based on serial serologic studies; both had antibody in the cerebrospinal fluid as well as the serum. The patients were treated successfully with amphotericin B and had favorable clinical responses. Three control patients with active histoplasmosis and positive serum serologic tests, but without meningeal involvement, did not have antibody in the cerebrospinal fluid. Patients with chronic meningitis of obscure cause should have serial serum and cerebrospinal fluid antibody studies for H. capsulatum.
Adult↗
Severe anal ulceration secondary to Histoplasma capsulatum in a patient with HIV disease.
Severe fungal infections have become increasingly common in the immunocompromised patient, including those infected with human immunodeficiency virus. Histoplasma capsulatum occurs in about five per cent of acquired immunodeficiency syndrome patients in the endemic areas of the Mississippi and Ohio River Valley. Immunocompromised patients who present with severe ulceration and suppuration of the anus require exam under anesthesia and thorough laboratory evaluation for opportunistic infections. Thus, surgeons play a critical role in diagnosis and initiation of treatment. A case of infiltrating H. capsulatum of the anus is presented, including the natural history, presentation, diagnosis, and treatment.
AIDS-Related Opportunistic Infections↗
[Investigation on the epidemiology of Histoplasma capsulatum infection in Nanjing district].
Two hundred and ninety-two permanent or temporary residents in Nanjing district were tested with histoplasmin (Histolyn-CYL, ALK/Berkeley Laboratories, USA) and PPD. Forty-nine (16.78%) subjects reacted to histoplasmin with 5.0-23.0 (9.5 +/- 4.2) mm induration. Positive reaction rate among people without pulmonary diseases (normal group) was 15.10% comparing to 17.74% to patients with pulmonary diseases. Positive reaction to PPD with 5-50 (14.2 +/- 4.7) mm induration was 56.16%, with 59.43% in normal group and 54.30% in patients with pulmonary diseases while 8.90% subjects reacted to both histoplasmin and PPD, 7.88% of the research subjects reacted to histoplasmin but not to PPD. Result suggested that there was herd infection of Histoplasma capsulatum in Nanjing district.
Adult↗
[Cerebral miliary granulomatosis with Histoplasma capsulatum in an HIV seronegative patient].
A 51 year old patient who worked in Africa for eight years, presented twelve years later a progressive ataxia associated with headaches. Neuroimaging studies done after a partial complex seizure demonstrated multiple supra and sub-tentorial cortical ring enhancing lesions. Histoplasma capsulatum histoplasmosis was found on histological examination of brain biopsy and confirmed by isolation of the fungus. Medical treatment with intravenous amphotericin B followed by oral itraconazole (400 mg per day) improved both clinical and radiological status. This observation of cerebral histoplasmosis is rather unusual for a seronegative HIV patient in a non endemic area.
Amphotericin B↗
[Disseminated histoplasmosis caused by Histoplasma capsulatum with cerebral involvement occurring 13 years after the primary infection].
A 49-year-old man with disseminated histoplasmosis (pulmonary and central nervous system involvement) successfully treated with ketoconazole and fluconazole combination is reported. Histoplasma capsulatum infection of the central nervous system is extremely rare in France partly because the organism is not endemic. Oral treatment with newer triazoles may be useful for central nervous system histoplasmosis, but additional information is needed to establish their effectiveness.
Antifungal Agents↗
Epidemiological investigation of Histoplasma capsulatum infection in China.
OBJECTIVE: To provide reliable information concerning the presence or the absence of Histoplasma capsulatum (H. capsulatum) infection in China, and data concerning this respect. METHODS: Three hundred normal people and 435 hospitalized patients, who lived in Hunan and Jiangsu provinces, and the Xinjiang Autonomous Region, were tested with yeast-phase histoplasmin (ALK/Berkerley Biologicals Laboratories, USA) and human pure protein derivative of tuberculin (PPD) on the volar surface of the forearm. Any reaction to the antigens over 5.0 mm in diameter of induration at 48-72 hours was considered positive. RESULTS: A total of 138 subjects (18.8%) in 735 patients reacted to histoplasmin with 5.0-45.0 (9.1 +/- 4.3) mm indurations. Significant differences of positive skin reaction rates in normal subjects were found in Hunan, Jiangsu and Xinjiang (8.9% vs 15.1% vs 2.1%). The overall positive rate of patients was 25.5%. Patients with tuberculosis [31.7% (78/246)] had a significantly higher positive skin reaction rate in comparison with those suffering from pneumonia [17.7% (11/62)], lung cancer [20.9% (9/43)], chronic obstructive pulmonary disease [17.3% (9/52)] and other diseases [12.5% (4/32)] (P < 0.01). Of 562 cases, 292 cases (52.0%) reacted to PPD with indurations of 5-50 (13.7 +/- 4.9) mm in diameter, 63 cases (11.2%) reacted to both histoplasmin and PPD, while 38 cases (6.9%) reacted to histoplasmin but not to PPD. CONCLUSIONS: The data suggest that there is H. capsulatum herd infection in China. The infection rate in Southeast China is higher than that in the Northwest, and the infection rate of patients with pulmonary tuberculosis is higher than that of normal persons and other pneumonopathy patients.
Adult↗
[Generalized histoplasmosis due to Histoplasma duboisii with mediastino-pulmonary infection. Cure after 15 months of treatment with ketoconazole].
We report a case of a young burkinabian, who presented with the disseminated african form of histoplasmosis, Histoplasma duboisii. There was pulmonary mediastinal disease with superficial lymphadenopathy and also hepatic involvement. The diagnosis was achieved by a histological examination of the peripheral glands and micrological examination of the expectorate. A clinical cure (despite the radiological persistence of enlarged but stable left hilar glands) with the follow up 10 months was achieved after 15 months of treatment with ketoconazole in a dose which was increased to 10 mg/kg/day.
Biopsy↗